Patient Pathways: Rectal Cancer

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Rectal Cancer

Rectal cancer refers to a malignant tumor that develops in the rectum, the last part of the large intestine immediately before the anus. This type of cancer belongs to the group of colorectal carcinomas, but differs from colon cancer in terms of its location, some symptoms, and treatment methods. Most cases of rectal cancers are a consequence of chromosomal instability.

According to data from the Croatian Institute of Public Health, colorectal cancers are among the most common malignant diseases in Croatia. Approximately 3,000 new cases of colorectal cancer are diagnosed each year, with rectal cancer accounting for a significant portion of these cases.

Due to the complexity of treatment and various therapeutic options that include surgery, radioactive iodine, and hormone therapy, patients with rectal cancer face numerous challenges. Therefore, it is crucial to ensure comprehensive supportive measures that include medical care, psychological support, and education to improve the quality of life for patients and facilitate coping with the disease.

Based on its location, rectal cancer can be classified into three categories: low, middle, and high.

Patient Pathways

Creating a comprehensive plan for treating rectal cancer includes steps from initial presentation and diagnosis to treatment and follow-up. Below is a detailed plan:

1. Diagnosis

The patient presents with symptoms such as changes in bowel habits (diarrhea, constipation, or a feeling of incomplete evacuation), blood in the stool, pain in the abdomen or rectum, unexplained weight loss, weakness, and fatigue.

Consultation with a general practitioner (GP): The patient visits their GP.

Medical history and physical examination: A detailed patient history is taken.

Initial tests: Colonoscopy and non-invasive tests.

Referral to a specialist

Referral to a radiologist and oncologist.

Diagnostic Evaluation

• Digital rectal exam (DRE)
• Endoscopy with biopsy for histopathological confirmation
• CT, MRI of the liver and abdomen - to locate potential metastases
• Endoscopic rectal ultrasound - to define early stages of treatment
• Pelvic MRI - to define the locoregional clinical stage.

2. Treatment

Multidisciplinary Team (MDT) meeting

MDT discussion: Review of diagnostic findings with specialists including endocrinologists, surgeons, oncologists, radiologists, and pathologists.

Treatment plan development: Based on the stage of rectal cancer and the patient’s overall health.

Treatment options

• Transanal endoscopic microsurgery
• Extramural vascular invasion
• Chemoradiation
• Mesorectal fascia
• Short-course preoperative radiotherapy
• Total mesorectal excision.

3. After treatment: Follow-up, Rehabilitation, and Survival

Follow-up: Intensive care unit, regular check-ups with physical exams.

Periodic imaging (ultrasound, CT, or MRI) to monitor for recurrence.

Rehabilitation: Physical therapy to recover from surgery.

Psychosocial support: Counseling and support groups for emotional well-being.

Long-term survivorship care: Monitoring for late effects of treatment. Promotion of health and lifestyle changes to improve overall well-being.

Secondary prevention: Screening for other malignancies and maintaining a healthy lifestyle.

4. Palliative Care (if applicable)

Palliative treatments: To relieve symptoms and improve quality of life in advanced cancer.

Pain management: Medications, nerve blocks.

Symptom control: Management of shortness of breath, pain, etc.

Hospice care: For end-of-life care if curative treatment is no longer an option.

Challenges Faced by Rectal Cancer Patients Throughout Their Treatment Journey

Challenges during diagnostic evaluation

A rectal cancer diagnosis can be a stressful and challenging time for patients. Support during this phase can significantly improve the patient’s emotional and physical well-being. Patients with rectal cancer face various challenges during diagnosis, including physical, psychological, financial and professional difficulties, as well as a lack of information.

Physical Challenges

Symptoms of the disease: Blood in the stool is the first symptom of rectal cancer, which can cause discomfort and anxiety. In addition, there may be discomfort during a colonoscopy, prolonged fatigue, and unexplained weight loss.

Psychological Challenges

Fear of cancer diagnosis, uncertainty about treatment: fear of possible complications and side effects of treatment. The process of emotional acceptance of a cancer diagnosis can be very stressful and challenging. The patient needs emotional support, which puts pressure on family and friends to provide support.

Social isolation: A feeling of isolation due to illness and a need for privacy.

Financial and Professional Challenges

Absence from work: Frequent medical checkups and treatments can lead to absence from work, which can affect career and financial stability. Costs of diagnosis and treatment, insufficient health insurance.

Lack of Information

Patients often have difficulty finding reliable and understandable information about the disease, diagnostic procedures, treatment options, and their rights.

Insufficiently clear communication with doctors: the complexity of medical terminology and lack of time during consultations can make it difficult to fully understand the diagnosis and treatment options.

Challenges during treatment

Physical Challenges

Lack of energy: Constant fatigue and exhaustion due to treatment and hormonal Bleeding during surgery, wound infection, wound dehiscence, pelvic nerve damage leading to problems with urination, bowel movements, or erectile function.

Lack of energy: Constant fatigue and exhaustion due to treatment and hormonal imbalance. Scars from surgery can affect appearance and self-confidence.

Cardiovascular problems: Hormonal imbalance can affect the heart.

Hair loss: It can occur due to radiation therapy or chemotherapy. Skin problems: dry skin, itching, or rash due to therapy. Eye problems: Dry or irritated eyes due to radiation therapy.

Metabolic problems: Changes in metabolism due to hormone therapies.

Weight changes: Weight gain or loss due to hormonal changes.

Psychological Challenges

Fear and anxiety: Fear of the disease, treatment, side effects, and uncertainty about the outcome, anxiety related to regular checkups and fear of recurrence.

Depression: Feelings of hopelessness, loss of interest in everyday activities, isolation.

Changes in body image: Distress due to physical changes, such as scars or weight changes.

Treatment-related stress: Psychological stress due to intensive treatments and their impact on everyday life.

Relationship with partner: Sexual problems, decreased libido, and emotional distance due to illness.

Family Relationships: Tensions within the family due to stress, changes in roles and responsibilities.

Social Isolation: Withdrawal from social activities due to fatigue, discomfort, or fear of exposure to infections during treatment.

Financial and Professional Challenges

Reduced ability to work due to fatigue, side effects of treatment, and emotional problems.

Absence from work: Frequent medical appointments and treatments that require time off work, which can affect career and financial stability.

High costs of medications, surgeries, therapies, and other medical services, travel, and accommodation costs for patients who have to travel to healthcare centers. Reduced income due to reduced work capacity or job loss. Ongoing costs associated with long-term follow-up and health maintenance.

Lack of Information

Need to understand complex medical information and make informed decisions. Difficulty in making treatment decisions due to lack of reliable and understandable information or conflicting advice. Unawareness of patient rights. Lack of information about healthcare providers during treatment.

Challenges during rehabilitation and disease monitoring

Physical Challenges

Fatigue: A frequent feeling of exhaustion and lack of energy can persist long after treatment is completed. Fatigue can be a consequence of the disease itself, surgery, chemotherapy, or radiotherapy.

Pain: Pain in the abdomen, rectum, or other parts of the body where surgery was performed can last for several months. Pain can be the result of surgical incisions or internal scars.

Changes in bowel function: Patients may experience changes in bowel habits, such as diarrhea, constipation, incontinence, or a feeling of incomplete evacuation.

Scars and surgical complications: Scars after surgery can cause discomfort or pain, and complications such as infections or hernias may occur.

Nutritional deficiency: Due to changes in the digestive system, some patients may have problems with nutrient absorption, which can lead to anemia or other nutritional deficiencies.

Lymphedema: Swelling of the limbs may occur if lymph nodes were removed during surgery. This condition can be uncomfortable and require special treatment measures.

Stoma complications: If the patient has had a colostomy or ileostomy, they may experience complications such as skin irritation, infection, or difficulty adjusting to life with a stoma.

Sexual dysfunction: Men and women may experience sexual problems due to the physical and emotional effects of the disease and treatment. This may include decreased libido, pain during intercourse, or erection problems in men.

Neuropathy: Nerve damage from chemotherapy can cause tingling, pain, or numbness in the hands and feet.

Psychological Challenges

Fear of recurrence: Ongoing fear of the cancer returning. Anxiety and depression: psychological stress and emotional problems associated with recovering and fearing cancer recurrence. Social isolation: reduced social interaction due to fatigue, anxiety, or other symptoms.

Financial and Professional Challenges

Return to work: Difficulty returning to work due to physical and emotional limitations. Long-term financial burden associated with ongoing medical expenses.

Challenges during palliative care

The challenges faced by rectal cancer patients in Croatia and their families during palliative care are multifaceted and encompass several key aspects:

Limited access to palliative care: There is a significant gap between the demand for palliative care and available resources. Insufficient capacity of specialized palliative care providers.

Psychological Challenges

The psychosocial and emotional burden on patients and their families is often significant. Family caregivers often face high levels of stress and emotional distress. Cultural and ethical issues: Reluctance to discuss end-of-life issues can hinder the provision of effective palliative care. Ethical challenges in decision-making and care provision can also create additional stress for families and healthcare professionals.

Financial Challenges

The cost of care can be a significant burden for families, especially considering the long-term nature of palliative care. Financial pressure can further exacerbate the stress experienced by patients and their families, impacting their overall well-being and quality of life.

Challenges with care coordination: Effective palliative care requires coordination among various healthcare providers. In Croatia, there are challenges related to care coordination between hospitals, palliative care units, and home care services. Addressing these challenges requires a comprehensive approach that includes improving access to palliative care, providing emotional and psychological support to families, addressing financial burdens, and ensuring effective care coordination. Additionally, public education and awareness-raising about the benefits of palliative care can help reduce cultural and ethical barriers.

Challenges Faced by Patients After Completing Rectal Cancer Treatment

Physical Challenges

Fatigue: Fatigue is common even after treatment is finished. It can be caused by chemotherapy, radiotherapy, or the stress of battling cancer.

Changes in bowel function: Patients may experience long-term changes in bowel habits, including diarrhea, constipation, incontinence, or a feeling of incomplete evacuation.

Pain and discomfort: Pain in the area of the surgery can last for an extended period. Scars, internal scar tissue (adhesions), and postoperative complications can cause discomfort or pain.

Nutritional Deficiencies: Due to changes in the digestive system, some patients may have problems absorbing nutrients, which can lead to anemia or other nutritional deficiencies.

Neuropathy: Nerve damage caused by chemotherapy can lead to tingling, pain, or numbness in the hands and feet.

Lymphedema: Swelling of the limbs can occur if lymph nodes were removed during surgery.

Stoma complications: If a patient has had a colostomy or ileostomy, they may experience problems such as skin irritation, infection, or difficulty adjusting to life with a stoma.

Psychological Challenges

Cancer survivors often experience anxiety and fear of cancer recurrence, which can affect their emotional well-being. They may also face difficulties adjusting to life after treatment, including changes in their daily routines and life plans. The role of family members as caregivers often shifts after treatment ends. Their support remains crucial but may require adaptation to new circumstances and a decrease in the intensity of care.

Lifestyle and Prevention: Patients are encouraged to adopt healthy lifestyle habits, such as regular exercise, a healthy diet, not smoking, and stress management, to improve their overall health and well-being.

Financial and Professional Challenges

Returning to work: Many survivors face challenges in returning to work, including fatigue, reduced energy, and physical limitations after treatment. They need support in adapting to the work environment and managing employer expectations. Employers are often unsure how to provide support to cancer survivors returning to work.

Healthcare Coordination

Regular check-ups: It is important to continue with regular checkups to monitor for cancer recurrence or side effects of treatment. This includes blood tests and scans, such as ultrasound, depending on the risk of cancer recurrence.

Patients with rectal cancer face various challenges during their diagnostic, therapeutic, and rehabilitation journey, including physical, psychological, financial, and professional difficulties, lack of information, and healthcare coordination.

Providing comprehensive support that includes medical care, psychological support, education, and social services can significantly improve the quality of life and treatment outcomes for these patients.

Supportive activities for patients with rectal cancer

A coordinated multidisciplinary approach to providing supportive care in healthcare settings is essential to helping patients throughout their treatment journey. Such an approach significantly improves the quality of life for patients with rectal cancer by helping them cope with the challenges that the disease and treatment bring.

Civil society organizations, such as patient associations and cancer support organizations, can play a key role in informing patients about such support activities. They can also organize and provide some of the necessary support to patients to reduce physical, psychological, financial, and professional difficulties, address the lack of reliable and understandable information, and strengthen the coordination of healthcare not only within the healthcare system but also through activities aimed at actively involving patients in developing better national health guidelines and policies.

Supportive activities provided by healthcare institutions

Supportive activities for physical challenges

Support activities for rectal cancer patients within the healthcare system encompass a wide range of services aimed at improving patients’ overall quality of life. In addition to medical care, which includes regular monitoring through blood tests, ultrasound, MRI, or CT scans, and follow-up with specialist physicians, patients should have access to a multidisciplinary team of experts for optimal management of physical challenges.

General practitioner: Provides ongoing healthcare needs during and after treatment.

Oncologist: Manages overall treatment.

Dietitian: Provides nutritional advice and weight management.

Physiotherapist: Manages pain and improves mobility.

Psychologist: Assists with emotional issues.

Oncology nurses: Take care of you before, during, and after treatment, provide information about the daily treatment plan, and teach you how to use aids.

Supportive activities for psychological challenges

Cancer patients and their families almost invariably face numerous psychological challenges throughout the entire treatment journey. Professional psychological help in the form of individual counseling, group therapy, couples counseling, and family counseling is a crucial part of supporting cancer patients. Additionally, a psychiatrist may recommend psychopharmacotherapy to support patients.

Supportive activities for providing reliable and understandable information

Informed Consent: A signed form is proof that a conversation in which the doctor provides information to the patient about diagnostic and therapeutic procedures, risks, complications, and alternative treatments has led to mutual understanding. Detailed yet easy-to-understand educational content for patients is essential in this process, but often not available.

Right to a Second Opinion: Guaranteed by the Patient Rights Act. Patients always have the right to seek a second opinion on their health status. A second opinion is required to be given to the patient, upon oral or written request, by every healthcare professional with a high professional qualification and appropriate specialization who has not been directly involved in providing a specific form of healthcare service to the patient. In addition to the patient, the physician may also initiate the process of seeking a second opinion. In the case of diagnosing a rare disease, the inability to find (adequate) therapy, or the lack of appropriate technological equipment in a healthcare institution that prevents or hinders the diagnosis or course of therapy, physicians often seek help and confirmation from their colleagues from other institutions to ensure the best possible approach for each patient.

Supportive activities provided by associations

Supportive activities for physical challenges

Support related to side effects of treatment: organizing workshops and informational activities that educate patients on ways to manage side effects. Providing brochures and online resources with practical tips.

Support related to symptoms of the disease: access to medical professionals for early intervention and symptom management. Organizing counseling centers where patients can receive advice from medical professionals and psychologists. Including medical advisors in support programs.

Support related to metabolic disorders, nutritional problems, and lack of energy: connecting patients with nutritionists and endocrinologists through organized events and online consultations to personalize the patient’s nutrition plan, and collaborating with fitness and nutrition experts for personalized recommendations for moderate exercise. Organizing practical workshops on proper nutrition, creating educational materials.

Supportive activities for psychological challenges

Providing free or subsidized psychological counseling, organizing support groups, and telephone lines for psychological support.

For depressive disorders, assisting with finding a psychiatrist and therapist, and collaborating with them.

Organizing support groups for conversation and sharing experiences.

Organizing workshops and therapy groups that focus on body positivity and embracing change.

Providing free courses on meditation, yoga, and relaxation techniques.

Creating online resources and apps to support stress management.

Associations can organize workshops for couples, including counseling with sexual health professionals.

Organizing family therapy sessions and workshops that include all family members in the support process.

Connecting with peer support groups and social activities.

Organizing social events, online forums, and support groups where patients can connect and share their experiences.

Supportive activities for financial and professional challenges

Advice on employment rights and workplace adjustments. Providing legal advice and support to discuss workplace adjustments with employers. Organizing workshops on workers’ rights.

Connecting patients with financial advisors and organizing workshops on managing finances during treatment.

Providing information on financial support, organizing fundraising campaigns, and assisting in applying for financial assistance. Connecting patients with social workers and providing free financial advice.

Supportive activities for providing reliable and understandable information needed for informed participation in the treatment process.

Understanding the disease and treatment: education and informational materials. Organizing educational seminars and workshops with medical professionals. Distribution of brochures and online resources about the disease and treatment.

Supportive activities regarding patient rights

They provide information about rights and social assistance options. You can find everything about patient rights at this link of the IGET association - Institute for Gastroenterological Tumors: https://iget.hr/prava-osoba-oboljelih-od-onkoloskih-bolesti/

Examples of successful supportive activities of croatian associations

Civil society organizations, patient associations, play a vital role in providing support to rectal cancer patients. These groups often offer peer support systems where patients can connect with others going through similar experiences, providing a sense of community and understanding.

They can also organize educational workshops and seminars to inform and educate patients, empowering them to actively participate in the treatment process.

Patient associations are also active in healthcare and social care system policies by raising awareness among the public and policymakers about the needs of patients and informing patients about their rights.

Numerous civil society organizations operate in Croatia, providing support to cancer patients. The directory lists a large number of associations in Croatia, and we highlight a few here:

Croatian League Against Cancer

Address: Ilica 197, 10000 Zagreb, Croatia

Phone: +385 1 3771 428

Email: liga.protiv.raka@poliklinika-breyer.hr

Website: www.hrvatska-liga-protiv-raka.hr

Cro-ILCO

Address: Draškovićeva 35, 10000 Zagreb, Croatia

Phone: +385 1 4923603

Email: croilco@net.hr

Website: www.croilco.hr

We Are Not Alone (Nismo Same)

Address: Boškovićeva ulica 7b, Zagreb

Contact: 097 7561 683

Web: nismosame.hr

Institute for Gastroenterological Tumors (IGET)

Address: Klinika za tumore, Ilica 197, 10000 Zagreb, Croatia

Phone: +385 1 3786444

Email: info@iget.hr

Website: iget.hr

Available supportive materials for cancer patients

The Croatian translation of several Patient Guides was carried out by the Association of Women with Cancer SVE za NJU (EVERYTHING for HER) based on the approval of the European Society for Medical Oncology (ESMO).

ESMO Patient Guide: Living with Cancer

This Patient Guide to Living with Cancer has been produced by the European Society for Medical Oncology (ESMO) and the European Cancer Patient Coalition (ECPC) in collaboration with the International Psycho-Oncology Society (IPOS) to support you and those like you at this important time in your life.

This Guide provides information on coping with this new reality, life after primary treatment, preventive care, and long-term follow-up. It will also help you maintain a personal health record, i.e., plan your healthcare throughout your life with cancer.

The guide was translated by Dea Ajduković, Ph.D., and the translation was reviewed by Natalija Dedić Plavetić, Ph.D., MD, specialist in internal oncology, and Ljiljana Vukota, psychologist, on behalf of patients from the association SVE za NJU.

https://www.esmo.org/content/download/131276/2458900/1/ESMO-Vodic-za-Bolesnike-Zivot-s-Rakom.pdf

ESMO Personalized Medicine in Oncology: A Guide for Patients

This Patient Guide was initiated by the ESMO Working Group on Personalized Medicine to help patients, their families, and friends better understand the factors that can influence a personalized approach to cancer prevention, diagnosis, and treatment.

This brochure summarizes the current knowledge on the basic principles of personalized medicine, illustrating its application to several tumor types. Personalized medicine represents the future of cancer treatment, and for it to become a reality in the near future and enable better treatment of tumors, the role of patients is crucial.

In this expanding and evolving approach, ESMO is committed to educating patients so they can better understand its key principles and their own contribution to advancing therapy.

The Croatian translation of the Guide was made possible by the Association of Women with Cancer SVE za NJU based on the approval of the European Society for Medical Oncology (ESMO). The Croatian translation was reviewed by: Prof. Ljiljana Šerman, Prof. Floriana Bulić-Jakuš, and Ljiljana Vukota.

https://www.esmo.org/content/download/385655/7486427/1/HR-Personalizirana-Medicina-u-Onkologiji-Vodic-za-Bolesnike.pdf

ESMO Immunotherapy-Related Side Effects and their Management: A Guide for Patients

This guide is designed to help you and your family, friends, and caregivers better understand immunotherapy-related side effects and their management. It provides information on the most common toxicities associated with modern immunotherapies (known as “immune checkpoint inhibitors”), how your oncology team can manage those symptoms, and some things you can do yourself to help reduce their impact. The medical information contained in this document is based on the ESMO Clinical Practice Guidelines for the Management of Immunotherapy Toxicities, which are intended to help clinicians in diagnosing, treating, and monitoring these events. All ESMO Clinical Practice Guidelines are developed and reviewed by leading experts using evidence from the latest clinical trials, research, and expert opinion.

The Croatian translation of the guide was reviewed by: Natalija Dedić Plavetić, Ph.D., representative of the Croatian Society for Internal Oncology, Marko Jakopović, Ph.D., representative of the Croatian Thoracic Society, and Ljiljana Vukota, representative of the Association of Women with Cancer SVE za NJU.

ESMO Cancer Treatment During the Covid-19 Pandemic: A Guide for Patients

The guide provides information about the COVID-19 disease and its symptoms, as well as measures you can take to reduce your risk of infection. Additionally, the guide provides information about the impact of the COVID-19 pandemic on various aspects of cancer treatment, including possible changes to your treatment plan and medical checkups that may be needed to protect you from infection.

The Croatian translation was reviewed by: Prim. Paula Podolski, MD, PhD, President of the Croatian Senological Society, Borislav Belev, MD, PhD, Internist Oncologist, National Representative of the Croatian Society for Internal Oncology at ESMO, and Ljiljana Vukota, representative of the SVE za NJU association.

http://www.svezanju.hr/lijecenje-raka-tijekom-pandemije-covid-19-esmo-vodic-za-bolesnike/

ESPEN practical guideline: Clinical Nutrition in cancer

Malnutrition is a common feature of cancer patients and is a consequence of the presence of the tumor and medical and surgical anti-cancer treatments.

Malnutrition negatively affects quality of life and treatment toxicity, and it is estimated that up to 10–20% of cancer patients die from the consequences of malnutrition rather than from the tumor itself. Therefore, nutrition plays a key role in the multimodal management of cancer.

Strong evidence indicates that nutritional issues should be addressed from the time of cancer diagnosis, within the diagnostic and therapeutic pathway, and should be managed in parallel with anti-neoplastic treatment. However, worldwide, cancer-related malnutrition is still largely unrecognized, underdiagnosed, and undertreated in clinical practice.

These evidence-based guidelines have been developed to translate the current best evidence and expert opinion into recommendations for multidisciplinary teams responsible for identifying, preventing, and managing reversible elements of malnutrition in adult cancer patients.

Directory of associations offering supportive activities to cancer patients

Zagreb

Croatian League Against Cancer

Services: Psychological support, support groups, education, financial assistance.

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 1 3775 572, 0995361 386

Email: info@hlpr.hr

Website: https://www.hlpr.hr

Institute for Gastroenterological Tumors (Iget) Association

Activities: Counseling, education, campaigns to promote healthy lifestyle habits, connecting patient associations and medical professionals, developing informative content for patients.

Contact:

Address: Ilica 197, 10000 Zagreb

Phone: +385 955578 587

Email: info@iget.hr

Website: https://iget.hr

EVERYTHING for HER Association

Services: Psychological support, education, information, support groups.

Contact:

Address: Kneza Mislava 10, 10000 Zagreb

Phone: +38516418765

Email: info@svezanju.hr

Website: http://svezanju.hr

Coalition of Associations in Healthcare (KUZ)

Patient Rights Advocacy: KUZ is dedicated to protecting patients’ rights and representing their interests before healthcare institutions.

Education: Organizing workshops and lectures on patient rights.

Public Campaigns: Campaigns to raise awareness about patient rights and better access to healthcare services.

Counseling: Providing legal and administrative support to patients.

Contact:

Address: Trpimirova 11, 10000 Zagreb

Phone: +385 1 4572 100

Email: President Ivica Belina: ivica.belina50@gmail.com

Website: https://www.kuz.hr/

Croatian Society of Prostate Cancer Patients (HDBRP)

Activities: Providing psychological support, counseling and information to prostate cancer patients and their families, organizing lectures, distributing educational materials, and campaigns to raise awareness about prostate cancer prevention and early detection, organizing support groups where patients can share their experiences and receive emotional support, campaigns to raise awareness about prostate cancer and the importance of regular check-ups.

Contact:

Address: Ilica 65/1, 10000 Zagreb

Phone: not listed

Email: info@hdbrp.hr

Website: https://www.hdbrp.hr

Thyroid Disease Association

Activities: Providing individual and group psychological support to patients with thyroid diseases, organizing workshops, lectures, and distributing educational materials about thyroid diseases, counseling and supporting patients in the rehabilitation process after treatment, campaigns to raise awareness about thyroid diseases and the importance of early detection and treatment, an informative platform providing advice on diet, treatment, and symptom management.

Contact:

Address: Ulica Frane Petrića 5, 10000 Zagreb

Phone: +38513464 723

Email: udruga.stitnjaca@gmail.com

Website: https://stitnjaca.eu/

Krijesnica Association

Services: Psychological support, legal aid, financial assistance, workshops.

Contact:

Address: Prilaz Gjure Dežalića 50, 10000 Zagreb

Phone: +385 1 3770 477

Email: info@krijesnica.hr

Website: https://krijesnica.hr/

Split-Dalmatia County

County League Against Cancer - Split

Services: Education, support groups, psychological support.

Contact:

Address: Spinčićeva 1, 21000 Split

Phone: 021 556 476

Email: office@zlpr.hr

Website: http://www.zlpr.hr/liga/o-nama

Croatian Association for Patient Rights Promotion

Activities: Advising on patient rights and assisting in accessing healthcare services, education and information. Contact:

Address: Zrinsko Frankopanska 2b, 21000 Split

Phone: +385915027861

Email: info@pravapacijenata.hr

Website: https://pravapacijenata.hr/

Primorje-Gorski Kotar County

Nada Rijeka Association

Services: Psychological support, education, workshops.

Contact:

Address: Milana Smokvine Tvrdog 5/1, 51 000 Rijeka

Phone: 051 371 062, 097 613 9715

Email: klub.nada.rijeka@gmail.com

Website: https://klub-nada-rijeka.hr/

Osijek-Baranja County

Mammae Osijek Association

Services: Psychological support, information, support groups.

Contact:

Address: J. Leovića 4 (“Drava” Health Center), 31000 Osijek

Phone: 031 373366, 091/480-1102

Email: klubmammaeos@gmail.com

Website: https://mammae-klub-osijek.hr/

Istria County

League Against Cancer Pula, Stoma Club Pula

Services: Education, patient support, information.

Contact:

Address: Nobileova 1, 52100 Pula

Phone: 052 222 795

Email: liga.protiv.raka@pu.t-com.hr

Website: https://www.ilco.hr/index.php/drustva/pula

Zadar County

League Against Cancer Zadar

Services: Psychological support, education, information.

Contact:

Address: Veslačka 12, 23000 Zadar

Phone: +38523627 783

Email: info@ligaprotivrakazadar.hr

Website: https://ligaprotivrakazadar.hr/

Šibenik-Knin County

League Against Cancer Šibenik-Knin County

Services: Education, support groups, psychological support.

Contact:

Address: Trg Nikole Tomasea 2, 22000 Šibenik

Phone: 022 218993

Email: liga.sibenik@gmail.com

Find them on Facebook: League Against Cancer Šibenik-Knin County

Varaždin County

Mammae Varaždin Association

Services: Psychological support, education, workshops.

Contact:

Address: Graberje 33, 42000 Varaždin

Phone: 042/206-900

Email: mammae.klub.varazdin@vz.t-com.hr

Website: https://rakdojke.com/

Vukovar-Srijem County

League Against Cancer Vinkovci

Services: Education, support groups, information.

Contact:

Address: Trg bana Josipa Šokčevića 1, 32100 Vinkovci

Find them on Facebook: League Against Cancer Vinkovci

Međimurje County

County League Against Cancer - Čakovec

Services: Psychological support, education, information.

Contact:

Address: A. Schulteissa 19, 40000 Čakovec

Phone:

Email: liga.protiv.raka.medjimurje@gmail.com

Website: https://www.zlprck.hr/